Combining Voice Surgery With Other Operations
Voice surgery is rarely the only operation on someone's list. A tracheal shave, facial feminization surgery, chest or genital surgery and sometimes a second voice procedure all compete for the same calendar, and the order you do them in can matter more for voice than for almost any other area.
There are two reasons. Several operations work on the same piece of cartilage, so the first surgeon changes what the second one finds. And almost any later operation under general anaesthetic involves a breathing tube that passes between your vocal folds, which a newly operated voice box needs time to heal before it meets.
This guide covers which combinations surgeons do routinely, the order that tends to protect the voice, and how to space other surgery around it. Your surgeons set the plan. The point here is to make sure they are all working from the same one.
On this page
Voice and the tracheal shave
This is the pairing most people ask about. A tracheal shave trims the front of the thyroid cartilage to flatten the Adam's apple. It changes how your neck looks, not how you sound. But the same cartilage is where cricothyroid approximation places its stitches and where feminization laryngoplasty does its work.
That is why the usual advice is voice first, or both together with surgeons who plan them as one. A surgeon arriving for voice surgery after someone else has shaved the cartilage finds scar and missing landmarks exactly where they need to work. The reverse is much easier.
How it works in practice depends on the operation. A glottoplasty is done entirely from inside the mouth and leaves the outside of the cartilage alone, so it is easy to do first or under the same anaesthetic as a shave. A cricothyroid approximation and a shave both go through the front of the neck, and some surgeons do the two through one incision. A laryngoplasty usually includes a cartilage reduction already, so a separate shave is rarely needed afterwards.
If the shave is all you want, and voice surgery is not on your list, none of this applies. If voice surgery might come later, even years later, tell the shave surgeon so they can leave the landmarks a voice surgeon needs.
Before you book either
If both are anywhere on your list, see the voice surgeon first and ask them how they would like the shave handled. It is much easier to plan the order before anything is booked than to undo it afterwards.
Breathing tubes and timing
Most operations under general anaesthetic involve a breathing tube placed through the mouth and between the vocal folds. For most people that leaves nothing more than a sore throat for a day or two. For someone whose folds have just been stitched together or reshaped, it is a real risk to the result.
So the order matters in two directions. If you have voice surgery first, most surgeons want it well healed before another operation that needs a tube, and many suggest waiting several months. Ask your voice surgeon for their figure, and give it to the other surgeon's team when you book. If the other operation comes first, the voice surgeon will want to know about it, and may want to scope you before operating to check that the tube has left nothing behind.
Either way, tell every anaesthetist you meet afterwards, for the rest of your life, that you have had surgery on your voice box. It changes the size of tube they reach for and how carefully they place it. Keep a short note of what was done in your phone.
Before any later operation
Ask to speak to the anaesthetist before the day, and tell them what voice surgery you had and when. Have the operation note ready to send. It takes five minutes and it is the single most useful thing you can do to protect the result.
Facial feminization surgery
A tracheal shave is very often added to facial feminization surgery on the same day, and that works well, since it adds well under an hour to an operation you were already having.
Voice surgery on the same day as long facial surgery is less common. The airway is the focus of a voice operation, anaesthetic time adds up, and facial surgery can mean a long time with a tube in place, which is exactly what a new glottoplasty wants to avoid. Some surgical teams do combine them, usually with the voice work done in a particular order within the session. Others prefer to separate them by months.
I would let the voice surgeon decide this one. If they are comfortable combining with a facial team they know, it saves a recovery. If they are not, the reason they give is usually the airway, and that is worth respecting.
Combining voice operations
Some surgeons combine operations on the voice box itself. Glottoplasty with cricothyroid approximation is the usual pairing, either in one session or with the second done later if the first falls short. Laser work is sometimes added during a glottoplasty, or used months later as a top-up.
Doing two at once can give a bigger rise in one recovery. It can also make it harder to tell which part did what if the result needs adjusting. Ask the surgeon why they would combine for you rather than wait and see, and what the second step would be if the first was enough on its own.
Think about order the other way, too. Scar from a laser treatment sits in the same tissue a later glottoplasty works on, and some surgeons find it makes the second operation less predictable. If a small procedure is meant as a first step towards something bigger, ask the surgeon who would do the bigger one whether they would rather you skipped it.
Chest, genital and other surgery
Most other gender-affirming surgery is done by different surgeons in different hospitals, so it is rarely combined with voice surgery in one sitting. The question is spacing.
Voice rest sits badly with any recovery in which you need to ask for help, describe pain or talk to nurses. A long genital surgery recovery is the worst fit, and a chest surgery recovery is not much better in the first week. Most people put at least a few months between voice surgery and anything major, and many find it easiest to have voice surgery when the rest of the calendar is quiet.
The breathing tube rule applies here as well. If you have had voice surgery, the next operation's anaesthetist needs to know, and your voice surgeon will usually have a view on how long to wait.
For trans men and transmasculine people, relaxation thyroplasty is a specialist operation that usually comes once testosterone has had a long run. In practice it tends to be one of the last things on the list, not something to fit between chest and genital surgery.
Building the order
Put everything on one list, including the operations you might want later. Then show the whole list to each surgeon, not just the part they would do. It is the simplest way to catch a clash, and the surgeons I would trust most are the ones who ask to see it.
As a rough shape, many people go training, then voice surgery, then a tracheal shave or facial surgery once the voice has healed, with other operations spaced by months. That is a common order, not a rule, and your surgeons' advice for your situation overrides it.
Leave room for the training. Voice surgery is followed by months of therapy, and keeping the calendar clear around it gives that work, and your result, the attention it deserves.
Frequently asked questions
Should I have voice surgery or a tracheal shave first?
Usually voice surgery first, or both together with surgeons who plan them as one. See voice and the tracheal shave.
Can I have voice surgery on the same day as facial feminization surgery?
Some teams do, many prefer to separate them. The airway is the main reason. See facial feminization surgery.
How long after voice surgery can I have another operation?
It depends on the operation and your surgeon, and many suggest waiting several months before anything that needs a breathing tube. See breathing tubes and timing.
Does a breathing tube damage a glottoplasty?
It can if it is placed too soon or carelessly, which is why timing matters and every later anaesthetist should know. See breathing tubes and timing.